NUR 139 Acid base imbalance final study guide

ACID BASE IMBALANCE
Respiratory Acidosis- ph- less than 7.35, CO2 greater than 45
Respiratory Alkalosis- ph- greater than 7.45, CO2 less than 35
Metabolic Acidosis- ph- less than 7.35, HCO3 less than 22
Metabolic Alkalosis- ph- greater than 7.45, HCO3 greater than 28

Respiratory Acidosis
Causes: CNS, muscle fatigue, mechanical ventilation, drugs, lungs, neuromuscular
junction, metabolism, O2 excess, COPD
S&S: H/A, changes in LOC, hyperkalemia, dyspnea, hypoventilation
Respiratory Alkalosis
Causes: hyperventilation, anxiety, PE, fear, mechanical ventilation
S&S: seizures, deep rapid breathing, hyperventilation, tachycardia, decreased BP,
hypokalemia, numbness & tingling, lethargy/confusion, N/V
Metabolic Acidosis
Causes: renal failure, RA, DKA, lactic acid, infusion of ammonium chloride, diarrhea,
fistulas in intestines
S&S: decreased BP, H/A, hypercalcemia, changes in LOC
Metabolic Alkalosis
Causes: increased HCO3, decreased H, NG suctioning, vomiting, hypercortisolism,
overuse antacids
S&S: confusion, dysrhythmias, tachycardia- decreased K, hypoventilation, dizziness,
increased irritability, N/V/D, increased anxiety, seizures, tremors, muscle cramps,
paresthesia, hypocalcemia



ELECTROLYTE IMBALANCE
Hyponatremia Hypernatremia
 Neurological  agitation, confusion
 Weakness  muscle twitches, seizures
 NVD  monitor: BUN, HCT, SG
 FVE symptoms
 Increased body temperature
 Tachycardia
 Seizure precaution?



Hypocalcemia Hypercalcemia
 Hyperactive deep tendon reflexes  Skeletal muscle weakness: respiratory
 Increased GI (diarrhea, cramping) failure
 Cardiac dysrhythmias/arrest  Decreased GI
 Laryngospasm (most life threatening),  Increased HR, BP

, tetany, seizure  Immobility
 Parathyroid gland issues  Hyperparathyroidism
 Poor vitamin D  Excess Vit D
 Unexplained bone fractures  Cancer of bone
 Increased phosphate  Increased use of thiazides
 Mental status change
 Chvostek’s/Trosseau’s Meds:
 Inadequate absorption from small IV saline: promote excretion
intestine Lasix
 Renal disease Stop thiazide
 IBD Calcitonin
 Resections Hemodialysis
 Transfusions (citrates bind to K)
 Pancreatitis

Meds:
Calcium gluconate- do not take with meals:
cardiac arrest
Vit D w/ Ca: 1-2 hr after meals
Aluminum hydroxide: binds to phosphate




Hypokalemia Hyperkalemia
 muscle weakness, diminished skeletal  muscle twitching, later muscle
muscle activity weakness
 weak irregular pulse, thread  slow irregular HR, weak pulse
 orthostatic HOTN  low BP
 increased GI motility  slow GI motility, diarrhea
 diuretics, steroids, digoxin  K-sparing diuretics (Aldactone), ACE
 mental status change inhibitors
 cardiac dysrhythmias/arrest  Renal failure
 shallow respirations  Acidosis
 abdominal distention Meds: Lasix
 metabolic alkalosis Sodium polystyrene sulfonate:
(kayexalate)
Meds: K Insulin w/ glucose
-w/ juice or H2O bicarb
-dilute as directed powders
-do not crush
-do not take with K-sparing

,Hypomagnesemia
-Trousseau’s/Chvostek’s
-dysrhythmias/arrest
-loss through GI/renal
-assess history of alcohol abuse
-like hypocalcemia
Meds: Magnesium sulfate

Pressure sensors: stimulate or inhibit ADH from pituitary through negative feedback
Hydrostatic pressure: filtration through a semipermeable membrane, fluid within blood vessel
brings H2O into tissue and cell bringing nutrients into cell/tissue

Osmolality: 270-300
-high dry

Diffusion- solutes of higher to lower concentration
Osmosis- solutes of lower to higher concentration, high concentration of water to low

Dehydration
-hypovolemia: decreased blood volume, hemorrhaging
-relative hypovolemia: fluid from vascular space goes into interstitial space
S&S:
-thirst
-rapid, weak thready pulse
-low BP
-decreased tear formation, dry skin, dry mucous membranes
-urine output decreases and becomes concentrated
-temperature rises (may not notice in old, temp decreases)
-poor skin turgor
-weight loss
-constipation
-orthostasis
-shallow respirations
Diagnostics:
-BUN, Na, HCT elevated
-SG increases >1.030; most accurate test
-serum osmolality increased
Interventions:
-monitor weight
-evaluate mental status
-I&O’s
-increase fluids, PO first

, -don’t over or under hydrate

Fluid Volume Excess
-excess fluid in intravascular space
Causes: poor organ function, eating too much salt, corticosteroid use, excess IV fluids or
ingestion of water
S&S:
-increased BP
-bounding pulse
-respirations increased and labored
-neck vein distention
-pitting edema in feet and legs, check sacrum
-diluted urine
-possible increase in UO
-weight gain
-moist crackles, dyspnea
-ascites
Diagnostics:
-BUN, Na, HCT decreased
-decreased SG
-decreased serum osmolality
Interventions:
-weight and urine output
-place in semi or high fowler’s
-turn frequently
-O2, assess lung sounds
-administer diuretics
-2g sodium restriction




SKIN
Stage 1: skin intact, red, does not blanch
Stage 2: break in skin w/ partial thickness skin loss
Stage 3: full thickness loss into SQ, may eschar, can heal, can never become 2 or 1, 4- yes
Stage 4: full thickness w/ damage to muscle, bone, support structures

Vesicle- small fluid filled blister
Macule- flat change in color usually less than 1cm
Papule- solid raised lesion
Cyst- closed sac or pouch